Overview of CareConnect profiled resources that include the Dosage structure

This implementation guidance applies to four CareConnect profiled resources that contain the same two structures;

Each contain two common structures;

Use of the STU3 Dosage datatype

The STU3 Dosage datatype is detailed in the HL7 FHIR specification and in the Dosage Structure section of this document.

Referencing a CareConnect-Medication-1 profiled resource

A reference to a CareConnect-Medication-1 resource can be implemented in three ways;

  • As an internal reference known as a “contained resource” where the resource is embedded inside the parent resource. This pattern is strongly discouraged in FHIR-based systems. It is used as the basis of examples here only to give clear, compact illustrative examples.
  • As an internal reference to a resource defined elsewhere within a FHIR bundle. Use this when an implementation requires the use of a bundle, for example NHS Digital Transfer of Care.
  • As an external reference to a RESTful API that would return a resource. This is the preferred pattern for referencing in production systems.

Contained resource

FHIR bundle

External reference

Use of the different dm+d concepts

All references to medication must use the NHS standard of dm+d, which is published as an independent terminology product using XML format data as well as being included in the SNOMED-CT UK Drug extension.

The dm+d code used within a medication resource will vary depending on the level of detail required by the prescriber. The most generic instruction would specify a Virtual Therapeutic Moiety (VTM) plus a dosage instruction. The most specific instruction, for the purposes of prescribing, would specify an Actual Medicinal Product (AMP) plus a dosage instruction.

alt text


The most generic representation of a medicine using only a Virtual Therapeutic Moiety (VTM) dm+d concept.

VTM plus Form

A coded form can be defined along with a Virtual Therapeutic Moiety (VTM) dm+d concept where the clinician does not want to be specific with a product-based instruction.

VTM plus Trade Family

The use of a VTM with a Trade Family is a use case not currently supported within FHIR STU3, or through a UK extension. There is currently no part of the Medication resource that is suitable to convey a SNOMED coded Trade Family. This includes the “manufacturer” which is a reference to a CareConnect-Organization-1 structure that is used for organisational contact details such as name, address, ODS code etc. opposed to a SNOMED coded Trade Family.


A Virtual Medicinal Product (VMP) or Actual Medicinal Product (AMP) coded concept. Both are pre-coordinated SNOMED-CT coded concepts. A VMP comprises of a medication + strength + form. An AMP may use either the same medication term as the parent VMP or use a 9191801000001103 Trade family (product) for the medication name. An AMP also defines the manufacturer.

Virtual Medicinal Product (VMP) Example

Actual Medicinal Product (AMP) Example

Tags: overview